"Medicine is a social science, and politics is nothing else but medicine on a large scale"—Rudolf Virchow

May 25, 2019

After serious setbacks in April led to a cluster of new polio cases, Pakistan is revamping its vaccination strategy in a renewed effort to wipe out the virus.

The country is one of just three — along with Afghanistan and perhaps Nigeria — in which polio is still endemic. Eradication of the virus in Pakistan is crucial to the drive to rid the world of polio, once and for all.

Now, vaccination teams will take a friendlier approach, ask fewer questions, make fewer follow-up visits, and stop recording extensive details about the families they visit, Pakistan’s polio eradication program announced.

Families were intimidated by the questions, and vaccinators spent too much time filling out the registration forms introduced in 2016, said Babar Atta, the polio coordinator in the prime minister’s office, according to local media.

A new vaccination drive is scheduled for the second week of June; thousands of teams will spread out around the country trying to reach almost 40 million children under age 10.

Many vaccinators will go house to house, while others will look for families with young children in refugee camps, train and bus stations, and at highway checkpoints.

Pakistan has had 17 cases of polio paralysis this year; it had only three by this date last year, and only 12 in all of 2018.

In mid-April, widespread panic among parents in Peshawar and the surrounding northern tribal areas forced the suspension of a national immunization drive.

A scaremongering video spread on Twitter, purporting to show students collapsing after getting an expired batch of vaccine.

The video seemed obviously fake. The boys in it flop prone across a hospital bed on cue after the speaker waves his hand; one even makes a funny face on camera. Also, expired vaccine — if it was expired — is harmless.

Nonetheless, “our TV channels found it profitable to cover this nonsense,” Aziz Memon, a textile executive who leads Rotary International’s involvement in Pakistan’s anti-polio campaign, said in an interview in New York. “It became a national event.”

Rumors spread that 50 children had died; mosques used their loudspeakers to tell parents to rush their children to medical care. Hospitals were swamped as more than 25,000 children arrived.

“No one had died,” Mr. Memon said. “But we had to call everything off.”

Local politics were behind the scare, he said. District elections were underway and the conservative Jamaat-e-Islami party was trying to discredit the polio campaign, which is supported by Prime Minister Imran Khan’s Tehreek-e-Insaf party.

The man speaking in the video was arrested.

To restore confidence, Mr. Memon added, the district health and communications ministers appeared on television giving vaccine drops to their own children.

Because suspicion of the campaign remains high in some areas — vaccinators have been accused of marking targets for American drones — interactions with families will now be briefer and less intrusive.

No WPV cases have been detected in Nigeria since 2016. WPV transmission has continued in Afghanistan and Pakistan in all previously identified reservoirs. The number and extent of cVDPV outbreaks increased in 2018. Countries with endemic polio have revised emergency action plans to innovate and intensify strategies to reach and vaccinate every child in underimmunized populations.

What are the implications for public health practice?

Successful implementation of locally relevant strategies in all areas will be essential to interrupting WPV transmission.

EVOLUTION OF THE EBOLA EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI

Friday, May 24, 2019

The epidemiological situation of the Ebola Virus Disease dated 23 May 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 1,888, of which 1,800 are confirmed and 88 are probable. In total, there were 1,254 deaths (1,166 confirmed and 88 probable) and 492 people cured.

• 343 suspected cases under investigation;

• 11 new confirmed cases, including 3 in Mabalako, 3 in Katwa, 2 in Butembo, 2 in Mandima and 1 in Kalunguta;

• 6 new confirmed deaths, including:

º 5 community deaths, 2 in Mandima, 1 in Butembo, 1 in Katwa and 1 in Kalunguta;

• 1 death at Katwa CTE;

• 2 new healings from the Katwa CTE.

/! \ The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

FIGURES OF THE RESPONSE

123,526 vaccinated persons

831 people vaccinated on 23/05/2019.

• Of those vaccinated, 34,048 are high-risk contacts (CHR), 60,522 are contacts of contacts (CC), and 28,956 are first-line providers (PPL).

• Persons vaccinated by health zone: 32,412 in Katwa, 25,048 in Beni, 15,798 in Butembo, 9,883 in Mabalako, 6,033 in Mandima, 4,379 in Kalunguta, 3,070 in Goma, 3,048 in Komanda, 2,569 in Oicha, 2,035 in Masereka, 1,998 in Lubero , 1,980 to Kayna, 1,935 to Vuhovi, 1,817 to Kyondo, 1,657 to Musienene, 1,487 to Bunia, 1,040 to Biena, 1,012 to Mutwanga, 690 to Rutshuru, 557 to Rwampara (Ituri), 527 to Nyankunde, 496 to Mangurujipa, 494 to Alimbongo, 420 to Mambasa, 355 to Tchomia, 342 to Kirotshe, 333 to Lolwa, 250 to Mweso, 245 to Kibirizi, 161 to Nyiragongo, 97 to Watsa (Haut-Uélé) and 13 to Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

Nine months into the second largest Ebola outbreak the world has ever seen—the tenth to hit the Democratic Republic of Congo—and the data are brutally clear: whatever we, Ebola responders, have been doing so far has not been working. The Ebola response in North Kivu and Ituri, the two provinces in the DRC currently affected by the epidemic, is failing. Almost every day seems to bring a new record number of cases—many of which end in deaths in the community—and the overall mortality rate remains well over 60%.

It was not supposed to be this way. After the 2014 west Africa Ebola outbreak there was a determination that such a catastrophe should not be allowed to happen again. UN agencies restructured their emergency response teams, research teams plowed millions of dollars into new pharmaceuticals, and academic journals were full of new insights and understandings into this previously poorly understood disease.

When the first cases of this outbreak were reported in August 2018, the Congolese government, WHO, the World Bank, and international medical organisations (including MSF) responded quickly, armed with strong financial support, a promising vaccine, new experimental treatments, and a far deeper understanding of Ebola than in 2014.

Despite this, the response has failed. In the volatile context of North Kivu—a region where armed groups, distrust of government, and socioeconomic injustices violently intersect—the Ebola response has been met with distrust and violent attacks on health workers and health facilities, the most recent being the killing of Dr Richard Mouzoko.

The social and political dynamics at play in North Kivu are complex, and there is no magic bullet to this crisis. It’s clear that the local community has lost what little trust it had in the ability of national and international organisations to respond to the epidemic, but what’s less evident is the next steps we can take to solve this problem. Based on our experience of working in North Kivu, these are some concrete suggestions of where we could go next.

Normalising Ebola

Of all the suspect cases admitted to Ebola centres, only a small minority (less than 10%) of patients end up having the disease, which reinforces the idea that Ebola is not real. Integrating Ebola into the regular system of care would help overturn this perception that these Ebola centres are part of a wider conspiracy against the population. Decentralising the isolation and testing of suspect patients and allowing them to remain at a facility they trust in their community would go a long way in increasing acceptance of the disease.

However, this can only be successful if we simultaneously re-institute sound triage practices, which isolate and test only those patients who respond to the standardised Ebola case definition. This would ensure that health centres (or Ebola centres) wouldn’t unnecessarily be overwhelmed with false suspect cases held for three days awaiting their results—at risk of getting Ebola, and at risk of not getting the care they need.

Improving access to diagnostics

One of the frustrating aspects of working in this epidemic has been the limited access to diagnostics. One of the most significant developments during the 2014 outbreak was the use of GeneXpert machines to improve the turnaround time of tests, but the full potential of this technology has not been reached during this outbreak. The complete oversight of laboratory results by the government, as well as the limited hours of operation of laboratories, has meant unnecessarily long waits for lab results. Delays in sample transportation has meant that patients (or the families of deceased persons) were often kept waiting overnight for a result that should have been available within four hours.

Humanising Ebola

One of the characteristics of this epidemic has been the aggressive attitude to finding new suspect cases. There have been reports of patients being forced into Ebola centres by the authorities. This is not only an affront to basic ethical principles, but it is also utterly counterproductive as it promotes anger and distrust amongst the communities we need to partner with.

EVOLUTION OF THE EBOLA EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI

Thursday 23 May 2019

The epidemiological situation of the Ebola Virus Disease dated 22 May 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 1,877, of which 1,789 are confirmed and 88 are probable. In total, there were 1,248 deaths (1,160 confirmed and 88 probable) and 490 people healed.

• 298 suspected cases under investigation;

• 11 new confirmed cases, including 6 in Butembo, 1 in Katwa, 1 in Beni, 1 in Mabalako, 1 in Mandima and 1 in Kalunguta;

• 7 new confirmed deaths, including

º 2 community deaths in Butembo;

º 5 deaths at CTE, including 1 in Mabalako, 1 in Butembo and 3 in Beni.

/! \ The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

NEWS

• This Thursday, May 23, 2019, the United Nations has taken a series of measures to strengthen their support for the response to Ebola in the Democratic Republic of Congo. In particular, by strengthening its political commitment and operational support, the United Nations wants to help improve the environment in which the response teams work to facilitate access to affected communities. Click here to read the full press release.

Security situation

• Nurses in the Musienene Health Zone have denounced the death threats and destruction of health facilities they have received in recent days because of their role in the Ebola response. The Musienene nurses held an extraordinary meeting on Thursday, May 23, 2019 to evaluate their working conditions. They asked the politico-administrative authorities to get involved in putting an end to this phenomenon of violence against health workers because, if the threats do not stop, they plan to go on a dry strike.

• Because of this targeted violence, several doctors and nurses in the Beni and Lubero territories had to move or temporarily leave their homes, forcing some health facilities to close their doors. This is particularly the case in the Kyondo Health Zone where activities have been suspended at the Kyakumba Health Reference Center since Tuesday, May 21, 2019, since the attending physician and the nursing staff left the feared zone for their safety.

• Between 1 August 2018 and 20 May 2019, 132 attacks against medical units were recorded as part of the Ebola outbreak, causing four deaths and 38 injuries among health workers and patients. As the Minister of Health, Dr. Oly Ilunga Kalenga, recalled at the 72nd World Health Assembly in Geneva, this violence against health workers must be condemned unreservedly and a clear distinction must be made between community involvement and targeted violence by armed militias. Linking the two is tantamount to stigmatizing the entire community of affected communities, portraying them as deeply violent communities, and blaming the health workers who are the first victims of this targeted violence.

FIGURES OF THE RESPONSE

122,695 vaccinated persons

• 827 people vaccinated on 22/05/2019.

• Of those vaccinated, 33,718 are high-risk contacts (CHR), 60,094 are contacts of contacts (CC), and 28,883 are first-line providers (PPL).

• Persons vaccinated by health zone: 32,281 in Katwa, 24,944 in Beni, 15,549 in Butembo, 9,596 in Mabalako, 6,033 in Mandima, 4,379 in Kalunguta, 3,070 in Goma, 3,048 in Komanda, 2,569 in Oicha, 1,998 in Lubero, 1,985 in Masereka , 1,980 to Kayna, 1,935 to Vuhovi, 1,817 to Kyondo, 1,647 to Musienene, 1,587 to Karisimbi, 1,487 to Bunia, 1,040 to Biena, 1,012 to Mutwanga, 690 to Rutshuru, 557 to Rwampara (Ituri), 527 to Nyankunde, 496 to Mangurujipa, 494 to Alimbongo, 420 to Mambasa, 355 to Tchomia, 342 to Kirotshe, 333 to Lolwa, 250 to Mweso, 245 to Kibirizi, 161 to Nyiragongo, 97 to Watsa (Haut-Uélé) and 13 to Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

EVOLUTION OF THE EBOLA EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI

Wednesday, May 22, 2019

The epidemiological situation of the Ebola Virus Disease dated 21 May 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 1,866, of which 1,778 are confirmed and 88 are probable. In total, there were 1,241 deaths (1,153 confirmed and 88 probable) and 490 people healed.

•307 suspected cases under investigation;

• 19 confirmed new cases, including 8 in Butembo, 5 in Katwa, 2 in Beni, 2 in Mabalako, 1 in Mandima and 1 in Kalunguta;

• 18 new confirmed deaths, including

º 8 community deaths, including 4 in Butembo, 2 in Mabalako, 1 in Katwa and 1 in Kalunguta;

º 10 deaths at CTE, including 5 in Mabalako, 2 in Butembo, 2 in Katwa and 1 in Beni;

• 3 new healings from the CTE Mabalako.

/! \ The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

NEWS

Operations of the response

• The sub-coordination of the Ebola response officially handed over a batch of 40 mattresses to the Baraka Hospital Center located in Munzambaye, in the Butembo Health Zone, on Wednesday, May 22, 2019. Two health workers from CH Baraka / Munzambaye, known as "Chez Bambuti" (pygmy note), representing their colleagues, received symbolically one of 40 mattresses.

• It should be noted that this donation is the result of the partnership concluded between CH Baraka and the teams of the response which, formerly, had difficulties to carry out their preventive health actions within CH Baraka. After realizing that their resistance to the teams of the response in their health facility posed a threat to the peaceful population, the medical staff of the latter ended up doing its "mea culpa" by radically changing its position and engaging in a perfect collaboration with the teams of the response. CH Baraka's health-care workers called on other health facilities that continue to resist following the Ebola outbreak in the Butembo Health Zone.

FIGURES OF THE RESPONSE

121,868 vaccinated persons

• 666 people vaccinated on 21/05/2019.

• Of those vaccinated, 33,385 are high-risk contacts (CHR), 59,649 are contacts of contacts (CC), and 28,834 are front-line providers (PPL).

• Persons vaccinated by health zone: 32.192 in Katwa, 24.884 in Beni, 15.259 in Butembo, 9.397 in Mabalako, 6.033 in Mandima, 4.319 in Kalunguta, 3.070 in Goma, 3.048 in Komanda, 2.569 in Oicha, 1.980 in Kayna, 1.972 in Lubero 1,945 at Masereka, 1,935 at Vuhovi, 1,817 at Kyondo, 1,587 at Karisimbi, 1,558 at Musienene, 1,487 at Bunia, 1,025 at Biena, 1,012 at Mutwanga, 690 at Rutshuru, 557 at Rwampara (Ituri), 527 at Nyankunde, 496 at Mangurujipa, 494 to Alimbongo, 420 to Mambasa, 355 to Tchomia, 342 to Kirotshe, 333 to Lolwa, 250 to Mweso, 245 to Kibirizi, 161 to Nyiragongo, 97 to Watsa (Haut-Uélé) and 13 to Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

As one of the lead coordinators of the national response to Ebola in Liberia, one of my main jobs was to ease the widespread fear. We did so by engaging with local communities. We recruited them to help in a number of ways, including being active case finders and leading negotiations with hostile community members.

A lack of trust is evident from troubling reports that many are resisting vaccination. We don’t yet know why. The resistance sits side-by-side with peoples’ receptiveness to other Ebola treatment.

From my previous experience it suggests that health workers must find a way to break through to clear the path for an effective vaccination drive – and to ensure that opposition doesn’t quickly grow into resistance to the overall response.

The grim facts are undisputed: the current Ebola outbreak is expanding, largely unabated. And there is a growing risk that it will spill over to neighbouring countries with the potential of spreading internationally. The possibilities are terrifying.

What can be done

What can leaders of the response do?

We had to think outside the standard conventions of emergency response.

First, they can incentivise community leaders (chiefs, healers, women, priests) on a fixed stipend to head the response in their respective towns or villages. Doing this will lead to a network of trusted messengers who can effectively communicate to a frightened, confused people. We did this in Liberia. And it can be done in the DRC, despite the challenges of war.

In Liberia we also incentivised a local gang that had been infected by offering them illicit drugs. It was unconventional – there were no rules for this kind of engagement – but it worked: we negotiated a self-quarantine of 32 homeless gang members. We also offered food to armed robbers in exchange for safe passage through a slum called West Point.

Second, food can be used to incentivise community response and volunteer self-quarantine. Food has historically being used as a weapon of war, but we turned it around in Liberia and used it as a force for Ebola containment. We did this successfully in collaboration with the World Food Programme. We provided food to entire villages where Ebola had occurred. Village leaders then decided that for 21 days no one would leave their villages and no new visitors would be allowed. By providing food and their basic needs these local leaders became empowered to work with their people to contain the outbreak.

Third, find all means necessary to incentivise the rebels and make them a part of the response. A trusted third party – like the Southern African Development Community, WHO or some other organisation – must convince the national government to allow them to meet the warring factions and give them the resources to take steps in their territory.

The ideal option is to appeal to all factions for a freeze on war for 42 days so that massive response efforts can be done. This was done by James P. Grant, the distinguished late president of UNICEF, in El Salvador. He launched the “Days of Tranquility” to allow the warring factions to cease fire to allow immunisation. He succeeded by using the influence of the Catholic Church.

In the DRC major stakeholders could be corralled into supporting a “42 Day Cease Fire for Ebola”. If we are to win the current war on Ebola, we must employ unconventional approaches, even ones that might be considered controversial. The fact is, people who are poor and neglected are more susceptible to infectious diseases and distrustful of authority. Distrust of authority, civil war and Ebola are a recipe for disaster even with the most costly response and medical counter measures.

EVOLUTION OF THE EBOLA EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI

Tuesday, May 21, 2019

The epidemiological situation of the Ebola Virus Disease dated May 20, 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 1,847, of which 1,759 are confirmed and 88 are probable. In total, there were 1,223 deaths (1,135 confirmed and 88 probable) and 487 people healed.

• 292 suspected cases under investigation;

• 21 new confirmed cases, including 5 in Beni, 5 in Kalunguta, 4 in Butembo, 4 in Musienene, 2 in Mabalako and 1 in Masereka:

• 5 new deaths of confirmed cases, including

º 3 community deaths, 2 in Butembo and 1 in Musienene;

º 2 deaths at the CTE of Beni;

• 3 new healed CTE patients, 2 in Butembo and 1 in Katwa;

• One health worker in Masereka, vaccinated, is among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 104 (5.6% of all confirmed / probable cases), including 34 deaths.

/! \ The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

NEWS

Operations of the response

• On the sidelines of the 72nd World Health Assembly (WHA) in Geneva, the Minister of Health, Dr. Oly Ilunga, the WHO Director General, Dr Tedros Adhanom Ghebreyesus, and the Director of the WHO Regional Office in Africa (AFRO), Dr Matshidiso Moeti, reported on the evolution of the Ebola outbreak and regional preparedness activities at a meeting of AMS Committee A on Tuesday 21 May 2019.

• All stakeholders recognized that the main barrier to ending this epidemic is the security context and violence against the response teams. The Minister of Health recalled that, from the point of view of public health, Ebola virus disease is not a particularly difficult disease to contain, especially since the country currently has a diagnostic, therapeutic medical arsenal and comprehensive preventive for the first time in the history of the virus. He recalled that to break the chain of transmission, it is enough to do a series of important activities around the confirmed cases, dead or alive, in particular the sensitization, the epidemiological investigations, the disinfection of the household, the vaccination and the follow-up of the contacts, and funerals worthy and secure. All these activities are available but teams are sometimes prevented from doing them because of insecurity or mistrust of the population. The Director of WHO emphasized that the Ebola epidemic in the DRC is still ongoing, not because the teams do not have the means or the skills but because they can not get regular access to the sick in the communities. If the security environment improves and access to communities is guaranteed, the response teams will be able to put an end to this epidemic, not because the teams do not have the means or the skills but because they can not get regular access to the sick in the communities. If the security environment improves and access to communities is guaranteed, the response teams will be able to put an end to this epidemic. not because the teams do not have the means or the skills but because they can not get regular access to the sick in the communities. If the security environment improves and access to communities is guaranteed, the response teams will be able to put an end to this epidemic.

• While welcoming the work of the Congolese Government in containing the Ebola outbreak, the Director of WHO-AFRO presented the progress of regional preparedness in case the Ebola outbreak spreads outside the DRC. To date, no cases of Ebola have been detected in DRC's neighboring countries thanks to the efforts of the Government and partners, who have examined more than 50 million travelers at the various health checkpoints located east of the DRC. country. As part of the regional preparedness plan, the nine countries bordering the DRC now have an emergency plan, 16 Ebola treatment centers have been built in neighboring countries, 270 technical experts have been deployed to support the efforts of border countries.

FIGURES OF THE RESPONSE

121,202 vaccinated persons

• 564 people vaccinated on 20/05/2019.

• Of those vaccinated, 33,118 are high-risk contacts (CHR), 59,281 are contacts of contacts (CC), and 28,803 are front-line providers (PPL).

• Persons vaccinated by health zone: 32,126 in Katwa, 24,788 in Beni, 15,069 in Butembo, 9,208 in Mabalako, 6,021 in Mandima, 4,235 in Kalunguta, 3,070 in Goma, 3,048 in Komanda, 2,569 in Oicha, 1,980 in Kayna, 1,972 in Lubero , 1,945 to Masereka, 1,935 to Vuhovi, 1,817 to Kyondo, 1,487 to Bunia, 1,558 to Musienene, 1,357 to Karisimbi, 1,025 to Biena, 1,012 to Mutwanga, 690 to Rutshuru, 557 to Rwampara (Ituri), 527 to Nyankunde, 496 to Mangurujipa, 494 to Alimbongo, 420 to Mambasa, 355 to Tchomia, 342 to Kirotshe, 333 to Lolwa, 250 to Mweso, 245 to Kibirizi, 161 to Nyiragongo, 97 to Watsa (Haut-Uélé) and 13 to Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

EVOLUTION OF THE EBOLA EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI

Monday, May 20, 2019

The epidemiological situation of the Ebola Virus Disease dated 19 May 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 1,826, 1,738 confirmed and 88 probable. In total, there were 1,218 deaths (1,130 confirmed and 88 probable) and 484 people healed.

• 245 suspected cases under investigation;

• 10 new confirmed cases, including 3 in Mabalako, 3 in Kalunguta, 2 in Beni 1 in Katwa and 1 in Butembo;

9 new confirmed deaths, including

º 4 community deaths, 2 in Kalunguta, 1 in Mabalako and 1 in Beni;

º 5 deaths at CTE, including 3 in Butembo, 1 in Mabalako and 1 in Katwa;

• 2 new healed from the CTE of Butembo.

/! \ The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

NEWS

Security situation

A vehicle from the response was slightly damaged and three policemen were slightly injured after a stone attack on a convoy of a dignified and secure burial team (EDS) at the Kanzunza cemetery in Butembo town on Sunday. May 19, 2019. In recent times, people living near certain public cemeteries are hostile to the EDS teams that are burying those who died of Ebola. The urban authorities and the coordination of the response organized a meeting on this subject on Monday, May 20, 2019.

FIGURES OF THE RESPONSE

120,638 vaccinated persons

• 986 people vaccinated on 19/05/2019.

• Of those vaccinated, 32,964 are high-risk contacts (CHR), 58,917 are contacts of contacts (CC), and 28,757 are front-line providers (PPL).

• Persons vaccinated by health zone: 32,010 in Katwa, 24,748 in Beni, 14,909 in Butembo, 9,138 in Mabalako, 6,006 in Mandima, 4,205 in Kalunguta, 3,070 in Goma, 3,048 in Komanda, 2,569 in Oicha, 1,980 in Kayna, 1,945 in Masereka , 1,935 in Vuhovi, 1,842 in Lubero, 1,814 in Kyondo, 1,558 in Musienene, 1,487 in Bunia, 1,357 in Karisimbi, 1,025 in Biena, 1,012 in Mutwanga, 690 in Rutshuru, 557 in Rwampara (Ituri), 527 in Nyankunde, 496 in Mangurujipa, 494 to Alimbongo, 420 to Mambasa, 355 to Tchomia, 342 to Kirotshe, 333 to Lolwa, 250 to Mweso, 245 to Kibirizi, 161 to Nyiragongo, 97 to Watsa (Haut-Uélé) and 13 to Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

On this platform a year ago, I described my recent visit to the Democratic Republic of the Congo, where WHO was responding to an Ebola outbreak in the western province of Equateur. That outbreak was controlled in just 3 months. But shortly after it ended, another outbreak started, this time in the eastern part of DRC.

And as you know, it’s still going.

I would like to commend my brother Dr Oly Ilunga, the Minister of Health of DRC, and the government for their leadership and commitment to ending this outbreak. We can be proud of the fact that so far, the outbreak has not spread outside two provinces in DRC. But I emphasise “so far”. The risk of spread remains very high. Because this outbreak is one of the most complex health emergencies any of us have ever faced.

We are fighting one of the world’s most dangerous viruses in one of the world’s most dangerous areas. We are fighting with even better tools than we used to extinguish the Equateur outbreak in three months. So far we have vaccinated more than 120,000 people. And we now have evidence that the vaccine is more than 97% effective in preventing Ebola. We also have 4 experimental treatments that we’ve used to treat 800 patients.

Since January, there have been dozens of attacks on health facilities in North Kivu. Every attack disrupts our operations. Every attack makes it harder to reach communities. Every attack gives the virus an advantage, and a disadvantage to the responders. Every life lost is a tragedy.

But every life saved is a triumph.

This is Faustin Kalivanda, an Ebola survivor from Beni. Faustin lost his wife and his five-year-old daughter Ester to Ebola. Despite this tragedy, Kalivanda believes that as a survivor he has a duty to protect others. He now works at the Ebola treatment centre as a nurse assistant.

These are the stories of hope that keep us going.

When I visited DRC following Dr Richard Valery’s death, I discovered that our staff were shocked and shaken, but undeterred. They told me, “We’re here to save lives. We will not be intimidated by violence. We will finish the job.”

I have also met personally with His Excellency the President of DRC and opposition leaders to urge a bipartisan approach to ending this outbreak. Because Ebola does not take sides. It’s the enemy of everybody. Unless we unite to end this outbreak, we run the very real risk that it will become more widespread, more expensive and more aggressive.

I have also briefed the Security Council twice on the outbreak. The Secretary-General and I have agreed on a further strengthening of the response across the entire UN system.